Greater Manchester Heart Failure Investigation Tool (GM-HFIT) work in Wigan Borough CCG

The CLAHRC Greater Manchester has recently completed the initial audits for the GM-HFIT project in Wigan Borough Clinical Commissioning Group (CCG). The project uses the GM-HFIT to audit GP practice registers and provide recommendations to them about their existing heart failure patients to help them improve their care. The tool also finds patients not currently coded with heart failure that meet the criteria for diagnosis or warrant further investigation.

The project was offered to the 13 practices in the Tyldesley, Astley, Boothstown, Atherton (TABA) locality group within Wigan Borough CCG in August 2012. Of this group, 12 practices opted to take up the project, which utilises local heart failure specialist nurses (HFSN) to conduct the GM-HFIT audit to ensure each recommendation is supported by expert clinical opinion.

With the initial audits now complete in all 12 participating practices. CLAHRC Greater Manchester is in a position to share the recommended cumulative outcomes for this project.

Verification

At the project baseline, practices had 359 patients coded with heart failure. Each of these patients was reviewed to verify that they should remain on the heart failure register. Of these, the auditing HFSN was satisfied that 270 (75%) had a fully documented rationale to be coded with heart failure. 35 (10%) were deemed inappropriate, with the rationale that evidence showed heart failure not to be present, and the recommendation that they were immediately removed from the heart failure register. The remaining 54 (15%) had some indication that heart failure may be present but the recorded information wasn’t sufficient to qualify this diagnosis. Recommendations were provided for all patients where any aspect of their care in relation to heart failure could be improved.

To help us benchmark the practices in the audit process, they were awarded an audit score and associated traffic light colour. This supported the delivery of the feedback to practices as it identified generic areas of heart failure care that they can improve upon. The mean score for practices in this scoring was 50, which gives them a green light. There was scope for practices to score up to 82 on the scoring system, so although we felt that the level of care provided was good, there was still plenty of scope for improvement.

Case finding

CLAHRC Greater Manchester has developed 15 searches to help case-find ‘missing’ heart failure patients. These searches look for drugs, codes and conditions that would strongly hint towards the patient having heart failure. Each one of these patients is then investigated to confirm heart failure, suggest a further investigation, or exclude it. In the 12 practices, the searches generated 2,903 patients for the HFSN to investigate for potential heart failure. From this group, it was recommended that 152 patients should be coded immediately with heart failure; this represents a yield of 5%. It was also recommended that a further 162 patients have some form of further investigation, such as referral for an echo to confirm or exclude heart failure. In total, 314 (11%) needed some form of recommended action on the back of the case finding work.

Next steps

We are now completing outstanding feedback sessions for practices to help them put the recommendations into action. After the sessions, the teams will have a short window of implementation to enact recommendations, before our team returns to complete a re-audit at the close of 2013 to evaluate the uptake of recommendations on the back of the audit.